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FINANCIAL DISCLOSURE REQUIREMENTS
Facilities and related organizations required to file financial disclosure
documents with this agency pursuant to the West Virginia Health Care Financial
Disclosure Act W. Va. Code § 16-5F-1, et seq. and the Financial
Disclosure Rule, 65 C.S.R. § 13 must submit the following documents within 120
days of the end of the facility or organization's fiscal year (unless otherwise
stated). If any document does not apply to the facility or related
organization, this must be stated in a cover letter accompanying the financial
disclosure submissions. The following is an overview of the requirements. For
the full text, please consult the above referenced links.
All covered facilities and related organizations must submit a:
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1. Complete audited financial report prepared and
presented by an independent accountant or auditor of the facility. All notes,
schedules and documents as required by the audit guidelines of the American
Institute of Certified Public Accountants shall accompany the report.
If an audited report is not prepared by the facility, the facility must provide
a statement of revenue and expenses, statement of changes in retained earnings
(fund balances), a statement of cash flows, a balance sheet and/or other
statement as required by generally accepted accounting principles. Multi-state
facilities must provide statements reflecting their West Virginia operations.
Under certain circumstances a consolidated format is acceptable for the audited
statements; but if a covered facility is included in the consolidation,
separate statements specific to the covered facility must be submitted. These
may be unaudited.
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All facilities except non profit, community-based primary care centers providing
primary care services, must also submit:
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2. Copy and proof of publication of the Class I legal
advertisement, to contain the following:
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A. Statement of revenue and expenses |
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B. Balance Sheet |
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C. Statement of changes in retained earnings (fund
balance) |
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D. Statement of ownership. This statement must disclose the nature of the
ownership of the facility, including any trade name, ownership by any parent
company and ownership of any subsidiary. It must also disclose persons owning
more than 5% of the capital stock outstanding and the dividends paid thereon,
if any, and to whom paid for the reporting period unless the covered facility
is duly registered on the New York stock exchange, the American stock exchange,
any regional stock exchange or its stock is actively traded over the counter. |
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E. Statement that the details of the ad are available
for copying and public inspection at the Health Care Authority, 100 Dee Drive,
Charleston, WV 25311. |
The legal ad must be prepared in accordance with generally accepted accounting
principles and must reflect the West Virginia operations. An incomplete
advertisement will not be accepted. The advertisement must be published in a
qualified newspaper in the West Virginia county where the operation is located.
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3. Statement of services available and rendered for
the West Virginia operations. If a facility is a nursing home, it shall
complete and return a copy of the Annual Report of Nursing Homes within thirty
(30) days of its receipt of the blank forms. If the facility is a hospital, it
shall complete and return a copy of its annual report for the American Hospital
Association within fifteen (15) days of rendering the report to the
Association. |
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4. Approved budget for the current fiscal year for
the West Virginia operations. For example, the FYE 2001 budget should accompany
the FYE 2000 financial disclosure submissions. |
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5. Schedule of current rates for all patient services
for the West Virginia operations. |
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6. Copies of Medicare, Medicaid, or other cost
reports required to be filed with governmental funding agencies. If cost
reports specific to West Virginia are not prepared, then submission of
consolidated reports will be sufficient to meet the requirement. Medicare cost
reports are due 150 days from the end of the fiscal year. Please remove any
patient identifying information prior to submission. |
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7. Statement of charges, fees, and salaries in excess
of $55,000 paid for goods and services rendered to the facility including the
amount and the name and address of each entity which rendered the goods or
services. Include any individual group, corporation or agency paid more than
$55,000 by the facility in the fiscal year. The HCA requires submission of such
statements only insofar as such payments relate in any manner to the West
Virginia operations. (see Financial Disclosure Policy Statement 2000-1, Forms
A, B, and C) |
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8. Statement of charges, fees, and other sums in
excess of $55,000 collected by the facility including the amount and the name
and address of each entity from which the sum was collected. Include any entity
which paid to the facility more than $55,000 in the fiscal year. This does not
apply to collections resulting from services rendered to patients. The HCA
requires submission of such statements only insofar as such collections relate
in any manner to the West Virginia operations. (see Financial Disclosure Policy
Statement 2000-1, Form D) |
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9. Copy of Form 10K filed by the facility or parent
organization with the Federal Securities and Exchange Commission. |
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10. Copies of all contracts that the facility entered
into with any individual or group of health care providers for the provision of
inpatient or outpatient services together with a schedule of rates charged by
the health care providers for their services. Any contracts related to the West
Virginia operations must be submitted. Please remove any social security
numbers prior to submission. |
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11. Copies of all income tax returns and applicable
substitutes, such as Form 990, which are required by state or federal laws. |
Additionally, a facility that is a hospital must submit the following:
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1. Copy of trial balance for the reporting period. |
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2. Copy of HCA Financial Report (Uniform Report),
including the Wage and Salary Survey. (Due 150 days from the end of the fiscal
year) (Submit in hard copy format and by electronic submission specified by the
HCA Board) |
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3. Uniform Bill (UB) data for each and every
inpatient including Medicaid and Medicare patients. This must be submitted on a
monthly basis in the format designated by the HCA board. |
All documents except income tax documents and confidential UB patient data are
available for public viewing and copying at the office of the Health Care
Authority. Most are available via the Authority's on-line document management
system.
All financial disclosure documents should be mailed to the attention of:
West Virginia Health Care Authority
Division of Data & Public Information
100 Dee Drive
Charleston, West Virginia 25311
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